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Clinical audit

clinical audit

arinbasu
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Clinical audit

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  1. Clinical Audit Arindam Basu University of Canterbury Email: arin.basu@gmail.com Prepared for IIHMR Students, July 2012

  2. What is Clinical Audit? • Clinical Audit is about • Clinical Care, and • About Change • Quality improvement process • Improves Patient Care Process • Improves Outcomes

  3. Key Elements of Clinical Audit • Systematic review of care • Against explicit criteria • Implementation of change

  4. Why Do You Need it? • You Need to Improvethe Quality of Care • How much Professional Freedom Should Be Exercised? • Are People losing faith in Medical Practitioners?? • You Needto Answer Questions • You Needto find deficiencies • You (May) needto change the way of doing things

  5. Who Can Do It? • individuals • Teams

  6. Stages of Clinical Audit Cycle • Cycle • Stages • Establishment of best practice • Measuring against criteria • Taking Action to Improve Care • Monitoring to Sustain Improvement BEST PRACTICE MEASUREMENT ACTION MONITORING

  7. Requirement • Interdisciplinary • Organizational Development • Statistics • Information Management • Who Can • Individuals • Teams • Multidisciplinary Staff • States • Districts • Country

  8. Create an Environment • Clinical Governance (UK) • In clinical governance, organizations are responsible for improving the quality of their services and safeguarding high standards of care by creating an environment where excellence will flourish (Dept of Health 1998)

  9. Three Criteria for Success • Supportive Organization • Staff Know How to do it • Actually Done

  10. Key Requirements • Clinical Governance • Self Regulation • Here the professional himself or herself regulates himself or herself. Does on his or her own • Lifelong Learning • Time • Technical Support • Library Services

  11. Stages • Prepare for Audit • Select Topics • Measure Performance • Achieve Improvement • Sustain Improvement PREPARE SELECT MEASURE IMPROVE SUSTAIN

  12. Preparing • Project Management • Project Methodology • Involve users in the process

  13. Sources of Information • Letters of complaints • Reports of critical incidents • Patients' stories • Focus Groups • Conversations • Direct observation of care

  14. How to Select Topic • What Contributes to High Cost of Care? • What Leads to High Volume of Use? • Which Factors Pose Risk to Staff? • What Are Key Risks to Patients?

  15. Question to the Class • Can you think of one condition in your hospital or care setting and give example of each?

  16. More on Topic Selection • Can It be Changed? • Is this topic a Priority Topic for the Organization? • Does this topic raise a serious quality threat? • Is Good Evidence Available for Benchmarking?

  17. What is the Purpose of Your Audit? • Improve Care • Improve blood transfusion processes in the hospital • Provide better support for patients with low back pain • Enhance Care • Change Care • Discharge quickly, less people indoors, more people to see in outdoors ... • Ensure Good Care is Given

  18. Provide Necessary Structures • Set up committee • Finalize Meeting Times • Arrange All Resources Required • Arrange for funding • Identify people who can do the audit

  19. Role of the Audit Team • Some people will lead the process • Some will collect data • Some will analyze data • Others will Write the report • Do Background Research, Librarians, etc ... • Talk to Physicians and Patients, etc ... • If needed, arrange for training

  20. Selection of Criteria • Define what you want to measure • Identify what elements can be measured objectively

  21. Three Elements of Care Quality • Structure of Care • Processes of Care • Care Outcomes STRUCTURE PROCESS OUTCOME

  22. Performance Measurement • User Group for whom this audit is relevant • Which Health Professionals are involved • What is the time Period

  23. How To Measure Performance? • Obtain Data from different sources • Consider Direct Observation • Read and Review Patient Case Notes • Decide on a Sample Size • Set up a Database • Analyze Data

  24. Improvement of Performance • You Need to Change Peoples’ Behaviour • Many Theories of Behaviour change, • No single applies fully • Think about change Management

  25. Stages of Change Model • Precontemplation • Contemplation • Preparation • Action • Maintenance PRECONTEMPLATION CONTEMPLATION MAINTENANCE PREPARATION ACTION

  26. Question to the Group What are Some Barriers to Change YOU HAVE FACED in your Organization?

  27. HowToBring About Change? • Provide Good leadership • Create A Supportive Organization • Make it Relevant to the Practice • Give Importance to All or Most Players Be the Change You Want to See in Others

  28. HowToSustain Improvement? • Monitor • Maintain • Use IT Intelligently • Identify what factors motivate people • Integrate audit into the culture • Provide Good Leadership

  29. How Does Healthcare IT Help? • Data collection • Data Analysis • Using clinical performance indicators

  30. Summary • What is Clinical Audit • Why Needed • For More Information, download and read the PDF and modify to suit your workplace

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